TACOMA — A Pierce County Superior Court judge on Thursday issued an arrest warrant for a Tacoma woman who has refused treatment for tuberculosis for more than a year.
Judge Philip Sorensen also upheld his earlier order requiring the woman to be confined in the Pierce County Jail or other qualifying facility for treatment and isolation until health officials determine she is safe to be discharged.
“Respondent’s objections to the order of February 24, 2023 are noted, preserved, and are insufficient to alter the court’s order,” he wrote in Thursday’s case update. “The Pierce County Jail shall be authorized to transport (the patient) to an appropriate designated facility within Pierce County including, but not limited to Department of Corrections facilities. Such facility shall accept (the patient) upon initiation of request from Pierce County Jail.”
Tacoma-Pierce County Health Department in a statement Thursday said, “This patient is still refusing to isolate and get the treatment she needs to treat her tuberculosis. The civil arrest warrant … will authorize law enforcement to detain her on or following Friday, March 3 and take her to a facility equipped for isolation, testing and treatment.”
It added, “We will continue to work through the court and to pursue all our options to protect the community and persuade the patient to voluntarily seek the life-saving treatment she needs.”
Sorensen on Feb. 24 ordered the woman held in civil contempt after violating multiple orders seeking compliance with treatment and isolation required by the Tacoma-Pierce County Health Department. That order called for a warrant to be served Friday or anytime after that for her to receive treatment in the jail should she continue to refuse to comply.
The woman’s attorney filed a brief Wednesday seeking a court-appointed guardian for the woman. The brief also opposed treatment in jail and divulged details of the woman’s actions up to this point.
In Thursday’s ruling, Sorensen wrote that a “court visitor is appointed at public expense: Suzanne Thompson-Wininger.”
In a Thursday filing before the hearing, the health department defended its petition that the the woman should be held in contempt and receive treatment in jail. The health department noted that she had not attended any court hearings since August.
The woman’s name and date of birth have not been publicly released.
The filing from the woman’s attorney, Sarah Tofflemire, was in response to TPCHD’S petition that led to Friday’s order of civil contempt and for a warrant to be issued after further noncompliance.
Tofflemire suggested that the woman’s lack of acknowledging and understanding what was happening was a significant factor in her refusal to voluntarily seek treatment.
Tofflemire’s filing stated, “She has not acknowledged the existence of her own medical condition. Because counsel is bound to represent the respondent’s stated interest, a guardian ad litem would be able to provide representation of her best interests, which are not currently clear.”
A guardian ad litem is defined by Washington courts as “an individual appointed by the court to represent the best interests of a child or incapacitated person involved in a case in Superior Court.”
The filing added that when “the respondent has joined proceedings, she has spoken out of turn with rapid, disorganized speech.”
It noted, “She has primarily focused on how she dislikes papers coming to her home, and not the import of the process in which she finds herself. She has repeatedly threatened suicide in relationship to papers being served upon her home.”
Previously, portions of the case’s details have been under seal to protect patient privacy, and neither Tofflemire nor TPCHD in the past answered questions from The News Tribune regarding the woman’s mental state.
This week, Tofflemire’s filing pushed back on the appropriateness of sending the woman to jail.
“Though Pierce County Jail may have plans in place for the incidental individual who turns out to be infected after booking on an unrelated matter, this does not mean it is equipped to handle long-term inpatient care for persons solely committed for that purpose,” the filing stated.
The filing also questioned whether there was adequate proof “to ensure sufficient due process for involuntary detention and treatment?”
In its filing, the health department called the defense “insufficient to overcome this court’s nondiscretionary duty to issue an an order to ‘transport the individual to a designated facility for isolation, treatment, and care until such time as the local health officer or designee determines that the patient’s condition is such that it is safe for the patient to be discharged from the facility.’”
The health department added it was not opposed to the woman receiving an appointed guardian “in future proceedings.” But it pointed out the need for a guardian did not change the circumstances of the petition holding her in contempt of court and receiving treatment in jail as the result of continued noncompliance.
The health department stated in its filing that she had “knowingly, willfully, and contemptuously violated this court’s orders” and listed the numerous court orders issued through 2022 supporting TPCHD’s petitions.
It also rejected Tofflemire’s contention that treatment in jail is inappropriate at this point.
“The local health officer, through TPCHD, has approved the Pierce County Jail as the appropriate facility via this petition requesting detention and treatment of respondent,” according to the filing.
The health department noted the woman could have moved for the appointment of a guardian “at any point since March 2022, when the attorney for respondent was first appointed.” It added, “To the point that respondent’s actions at previous hearings suggest she may need a guardian ad litem, TPCHD would note that respondent has not attended a hearing in this matter since August 2022.”
As for the woman not fully comprehending the proceedings, the department stated it had “provided respondent copies of all the orders in this matter in both English and her native language, a court certified interpreter has been at every hearing,” and that “native speakers have attended visits by TPCHD representatives and law enforcement.
“In addition, at every hearing where respondent was in attendance, this Court has provided an interpreter who translated the proceedings for respondent in real time. Respondent has thus been fully aware of the court’s orders and the rationale behind those orders.”
“Respondent has been given the opportunity to comply with this court’s orders to isolate and quarantine in the comfort and privacy of her home for more than a year,” it stated, and had repeatedly violated “by leaving her home without seeking treatment for her tuberculosis.”
It concluded that “the only viable course of action to protect public health is to require respondent to undergo treatment at the Pierce County Jail.”
TB case goes back more than a year
TPCHD went public with the TB case and woman’s lack of compliance in January of this year.
On Feb. 3, The News Tribune, citing court filings, reported the case started in January 2022 with an initial detention order for home isolation and treatment of TB. According to case filings, the woman started treatment but did not follow through with prescribed treatment.
The department repeatedly sought and received court orders for the woman to comply through the year. In March 2022, the court ordered an attorney to represent the woman, and entries noted a foreign language interpreter at proceedings. In January 2023 the health department filed another petition against the woman, citing further noncompliance with evidence of her as passenger in an auto accident and later seeking treatment at a local emergency department complaining of chest pains.
According to the petition, X-rays taken during the visit “demonstrate that she does have tuberculosis and it is progressing.” She also tested positive for COVID-19, the filing stated, “which also strongly suggests that she is not isolating as per this court’s order.”
Left untreated, active TB can become more difficult and expensive to treat, evolving potentially into an antibiotic-resistant strain.
On Wednesday, TPCHD director Dr. Anthony Chen and Nigel Turner, division director of Communicable Disease Control for TPCHD, offered an update on the case to the Board of Health.
Chen told board members that “most people willingly follow our guidance to recover from TB and prevent the spread to others.” He added that “this is a pretty rare instance. I’ve not seen this since I’ve been here.”
Turner added that “we’ve worked with Pierce County Jail staff to make sure that the person would be looked after by medical staff at the jail including the physician who provides oversight, and we’ve coordinated to make sure there’ll be continuity of care.”
Turner in a health department release Tuesday stated that the department still was working to seek compliance but was “closing in on our last option” of jail.
Tofflemire, the woman’s attorney, has repeatedly declined requests for comment on the case.
On Wednesday she told The News Tribune via email, “Because of the confidential nature of the many of the issues and on-going nature of the situation, I cannot make further comment at this time.”
The next Superior Court review hearing in the case is scheduled for April 7.
